When few countries can end HIV transmission from parents to children, then why cannot we?
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(CNS): The joint United Nations programme on HIV/AIDS (UNAIDS) is mobilizing governments and other partners to achieve new set of targets, referred to as, '90-90-90 by 2020', but with current set of tools, approaches, funding commitments, and challenge that HIV poses to the world, the goal seems certainly a bold and ambitious one. '90-90-90 by 2020' targets include increasing to 90% the proportion of people living with HIV who know their diagnosis, increasing to 90% the proportion of people living with HIV (PLHIV) receiving antiretroviral treatment (ART) and increasing to 90% the proportion of people on HIV treatment who have an undetectable viral load.
"Among the evidence-backed programmes to prevent transmission of HIV, one of which has proven to work so effectively so as to eliminate that form of transmission from a population is: eliminating mother to child transmission of HIV. Mother to child transmission has been eliminated from some nations already, such as Cuba, Thailand and Armenia. What is holding India back from joining nations that have ended HIV in infants" said Dr Ishwar Gilada, President of AIDS Society of India (ASI).
On the first day of 9th National Conference of AIDS Society of India (ASICON 2016) in Mumbai, the buzz was unanimous: how to accelerate progress towards eliminating mother to child transmission of HIV in India as well. This is perhaps one of the closest goalposts to 90-90-90 targets which India and other nations have promised to chase and rightly so.
Where are we now?
In 2015, there were an estimated 2.17 million people living with HIV in India, 40.5% of them being women and 6.54% children (142,000). Out of the 86,000 new infections in 2015, 10,500 were in children. 35,000 HIV positive pregnant women were still in need of prevention of parent to child transmission (PPTCT) services.
Dr Glory Alexander who founded ASHA Foundation in Bengaluru, who was conferred upon one of the most coveted awards in medicine in India, Dr BC Roy Award, by the President of India this year, was among the key speakers at ASICON 2016. She said that HIV positive children are indeed a tragic consequence of the epidemic. More than 90% of children get HIV from their mothers through parent to child transmission route, and without treatment 50% of them die by their second birthday. So if we can prevent parent to child transmission of HIV, we can eliminate HIV in children.
The most effective strategy for zero HIV infections in children is PPTCT, which the developed world has already implemented effectively. While India struggles with ensuring PPTCT for every eligible woman, few countries such as Cuba, Thailand etc have already eliminated parent to child transmission of HIV. Cuba was the first country to achieve it in 2015 and then Thailand followed suit in 2016, becoming the first Asia Pacific country to do so.
According to the World Health Organization (WHO), the criteria of elimination of parent to child transmission of HIV is when there are less than 50 new HIV infections in children per 100,000 live births; less than 5% HIV transmission in children in breastfeeding population and less than 2% in non breastfeeding population; more than 95% coverage of antenatal care, and more than 90% ART coverage of HIV positive pregnant women.